Infertility: Treatment, Procedure, Cost and Side Effects

Egg Freezing, which is also known as mature oocyte cryopreservation, refers to the method through which reproductive potential is restored among women. Eggs get harvested from the ovaries, frozen and in an unfertilized manner and are stored for purpose of using them later on. The egg freezing procedure is recommended for those women, who would like to delay conceiving baby due to various kinds of reasons.

Before the freezing of eggs, it is important to first retrieve the eggs. Let us look at how the eggs are retrieved, followed by the procedure of egg freezing through two different ways.

Retrieval of Egg

Egg Retrieval takes place just like it is done in case of in vitro fertilization (IVF). Women would need to be put under medication for hormones or through injections, which shall lead to the stimulation of ovaries, leading to more eggs getting matured. After this women would receive the necessary medication to stimulate ovulation and then the extraction of eggs takes place through the use of a needle. Specialists perform this whole procedure by putting women under the effect of anesthesia and are also guided by ultrasounds. Once the extraction is completed, the freezing takes place.

There are two different techniques involved in the egg freezing process. They include:

Slow Egg Freezing Method

A substance called cryoprotectant is used in order to protect the biological tissues from getting damaged out of freezing. This slow freezing method of getting eggs freezed relies on low initial concentrations of crytoprotectant. The cryoprotectant in low concentration is introduced when the egg is at a relatively warm temperature and still continues to experience the usual functions of a living cell. Then the cryptoprotectant would spread all throughtout thus fill the egg, hence replacing most of the water inside the egg. The egg is then inserted into a small container made of plastic and ultimately get placed inside a cooling chamber. The lowering of temperature, to around -6 degree centigrade, takes place through injecting very tiny amounts of liquid nitrogen into the cooling chamber. The cooling process is controlled by a computer.

The main purpose of these techniques is to avoid ice crystals from getting formed in the egg. During the spreading of the cryoprotectant, if the ice crystals are still present, they can cause damage to the egg and hence the egg may not survive the process of thawing. Then the temperature is lowered further to around -32 degree centigrade. By this time, the egg’s metabolic rate become slow. The container where the egg was placed, is then dipped inside the liquid nitrogen, forming a solid.

Rapid Egg Freezing Method or Vitrification

At the time of rapid freezing method, there is high concentration of initial cryoprotectant whereas the cell remains at room temperature. The egg is unable to stay for long in this temperature and thus gets poured immediately onto the liquid nitrogen. Cryoprotectant spreads at a rapid rate so as to avoid ice-crystal from getting damaged. Vitrification is a very new method for freeing eggs. Recent research has shown that vitrification of eggs largely improves the possibility for survival after thawing and the rates of pregnancy.

In this article we will be talking about Laparoscopy during Infertility and different other information about it which will be helpful for those who want to undergo a Laparoscopy.

What is Laparoscopy?

Laparoscopy is the method with the help of which doctors can diagnose infertility or treat different other problems related to fertility. Laparoscopy is a kind of surgery which is conducted with the help of two or three small cuts around the abdomen area. Through these small cuts the doctor inserts a laparoscope (thin, fiber optic tube) which allows the doctor to see inside the abdominal organs or they also insert any other important
surgical equipment.

Laparoscope is usually fitted with a light and camera which allows to monitor the inside of the women abdominal or genital system. Women are suffering from infertility and also if they experience pelvic pain, then it is highly possible that they will need to undergo a Laparoscopy. It can also be done once other infertility tests have been conducted.

Reasons For Laparoscopy Diagnosis

Your doctor may recommend you to undergo Laparoscopy because of many reasons.

Here are some of the most common and important reasons for Laparoscopy :

● If the woman experiences significant and frequent pain when she is engaged in
sexual intercourse.
● If the woman has severe and chronic menstrual cramps or pelvic pain at other
times of the cycle.
● If there has been a serious Pelvic inflammatory disease or severe pelvic
adhesions.
● If the doctor suspects that there is a chance of ectopic pregnancy and which can
be life threatening if left untreated.

So you can see that there are so many reasons because of which doctors can recommend you to choose Laparoscopy.

Why Is Laparoscopy in Infertility Important?

Infertility can be diagnosed with Laparoscopy and in many cases there have been instance that infertility was diagnosed only with this process. Laparoscope method not only helpa to identify the problem of infertility but also allows the doctor to check for much serious issues like cysts or tumors inside the abdominal system.

Laparoscopy is also very much beneficial for those who are suffering from significant pelvic pain. This process will help to remive the various scar tissues or endometrial residues which might be the reason for the pain.

Is Laparoscopy Safe?

Laparoscopy is a minimally evasive surgery which involves two or three very small incisions to be made around the abdomen. They will not hurt you much neither they will leave a mark of surgery for a long time. The Laparoscope is absolutely safe but there are some things to keep in mind that it is done in a medically induced environment which should not posses any threats of infection or pollutant. Laparoscopy is also recommended because there is not much postoperative problems which the patient face.

The freezing of sperm and embryos has been recognized for long as way to pursue treatments for fertility later on in life. Nowadays, the new techniques for freezing of eggs have lead to greater success. Due to this reason, the American Society for Reproductive Medicine no longer takes egg freezing as a procedure for experimental purposes.

Ideal Candidates for Egg Freezing

Now, we look into the candidates, who are ideal for going through the process of egg freezing. They include:

Women Who Intend To Put Off Childbearing: Generally fertility tends to decline with the advancement of age in women. Along with that, women who are in their twenties or thirties have less risk of miscarriage taking place and giving birth to babies with defects, in comparison to aged women. This happens mainly because of the increase in the percentage of embryos with abnormalities in chromosome, which occurs with advancement of age. Due to the problems that are associated with reproductive aging, a lot of women have preferred to use donor eggs, in order to increase their possibilities of bearing a child. Though this is an extremely effective method, yet the choice becomes hard to make as it involves the greatest amount of sacrifice.

Egg Freezing for Cancer Patients: Egg Freezing can be an extremely useful proposition for those who are diagnosed with cancer. The health data from 2001 onwards in the United States shows that around 8% of women who have been diagnosed with cancer, were aged below 40 years. The year 2007, saw an estimated 180,000 women getting diagnosed with invasive breast cancer. Around 5% of all those women who were aged below 40 years during the time of diagnosis, have never had the chance of becoming pregnant. Most of these women have stayed single. Women who have been diagnosed with breast cancer, 81% of those young women, who would go through treatments in the form of chemotherapy and radiation will remain alive and be free of ailments after a period of 5 years.

An unfortunate thing for all these women, who are in the childbearing age, chemotherapy and radiation would cause serious damage to the follicles which are in the process of getting matured in the ovaries.

Now, if a woman who has been diagnosed with cancer, looks to get involved with a male partner to conceive but still not ready to go for pregnancy, the ideal option would to create embryos through In Vitro Fertilization or IVF and go on to freeze the embryos. Embryo Cryptopreservation has gone on for year in a successful manner and is now known as the gold standard in preserving fertility.

Egg Freezing for Soldiers: Soldiers are also possible candidates, who could be ideal for egg freezing but unfortunately they tend to get overlooked. These people are often vulnerable towards getting pelvic injuries, which cause damage to their reproductive systems. Military records have shown that since the year 2003, well in excess of 1800 members, most of whom were Army troops, in Afghanistan and Iraq have gone on to suffer such injuries. There are cases when these injuries might well make a soldier incapable of bearing children.

There are two tubes on either side which connect the ovaries to the uterus. These are the fallopian tubes, and in the majority of the cases, this is where the fusion between the egg and the sperm happens. If there is any problem in either of the fallopian tubes, then the egg cannot travel down into the uterus and there cannot be fusion. Tubal infection or salpingitis and blocked fallopian tubes are some of the most common causes of infertility. In some cases, the sperm may travel up the fallopian tube halfway till the area of blockage and fuse with the egg. This is known as ectopic pregnancy, which is out of place.

Tubal infection is often a result of sexually transmitted diseases including trichomonas, gonococci, and chlamydia. Other general bacteria like strep and staph also produce salpingitis. In most cases, tubal ligation per se is not an issue. However, it can cause problems like blocked tubes or hydrosalpinx. In these cases, the complications arise. In some women, treating these could be the cure for their infertility itself. Blocked fallopian tubes can stop the eggs from traveling down the ovaries and fuse with the sperm. If the block is removed, then infertility is solved. Similarly, if the tubes are filled with pus as a result of the infection, then it does not produce a conducive environment for fertilization.

With IVF being used as a treatment for infertility, the tubes need to be cleared for infection or blockages. These might continue to pose problems and reduce the overall success rate of IVF. These are easy to diagnose so that the infection can be completely cleared and pus drained if required. Surgical debridement can also be done if required so that the tubes are cleared. In some cases, a part of the tube may be removed so that the issue is addressed completely. A course of antibiotics is often required to completely clear the infection. After that, once ovulation is stimulated, then the eggs can travel down so that they can be retrieved and frozen for further use.

Undetected blocked fallopian tubes of silent infection (chronic salpingitis, which does not present with any symptoms) can be one of the causes of failure to conceive with IVF. This can be quite demotivating for both the couple and the medical team. With IVF, there is no clear role for the fallopian tubes, as the eggs can be retrieved from the ovaries and placed directly in the uterus. So, in severe cases of infection, the tube(s) may be even completely removed to improve chances of fertility.

With infertility on the rise, more and more couples are turning to IVF as a definitive solution. Though there are some inherent risks with IVF, the success rates have gone up significantly over the last couple of decades. This has made it extremely popular for a couple facing infertility. IVF is no longer just a physical issue but also a hugely emotional one.

There are various factors which determine the success rate of IVF, and a thin endometrium is one of them. This is the inner lining of the uterus which should facilitate transfer and growth of the embryo throughout the course of pregnancy.

Ideally, the endometrium should be about 7 to 8 mm thick and have a 3-layered structure on ultrasound. If it is too thin, it may not be able to support the implantation of the fertilized egg. Further, even if it supports initially, as the embryo continues to grow, it may not be able to support the weight, leading to possible miscarriages.

Causes of the thin endometrium:

1. Reduced blood supply to the uterus
2. Reduced levels of estrogen
3. History of endometriosis
4. Scar tissue from prior uterine infections or surgery
5. Fibroids

While blood tests can help identify reduced estrogen levels, ultrasound can be used to measure blood flow to the uterus. The cause of thin endometrium needs to be addressed before going ahead with IVF so that the chances of success are increased.

Management:

1. Estrogen supplements can be given if there is estrogen deficiency. This is essential to promote overall uterine health, which can sustain a healthy pregnancy.
2. Surgically, uterine scraping where the top layers of the uterus are stimulated to produce a thicker lining. This is an outpatient procedure and produces excellent results in most women.
3. Increased intake of L-arginine is another way to improve uterine health. It promotes blood flow, thickens the uterine lining, and improves the success rate. About 500 mg per day for about a month is considered beneficial.
4. Uterine cleansing with for instance castor oil is another way to improve uterine lining.
5. Uterine massage where herbal oils are used to massage the pelvis has also shown great results. It helps improve circulation to the uterus and surrounding reproductive organs and improves their overall health. This should be done about 2 to 3 months before IVF and stopped after IVF (can result in dislodgement!!)
6. Acupuncture: Another well-established method to improve uterine lining and health is the use of acupuncture, as it improves circulation.
7. Eating healthy, vitamin supplements if required, getting adequate rest, moderate workout, and quitting smoking all go a long way in improving uterine health.